Training for GP's should be extended

The length of general practice training needs to be extended so that new GPs feel better prepared and more confident for independent practice.

That is one of the main recommendations of a three-year evaluation study of the RCGP training curriculum.

Commissioned by the RCGP, the independent study was carried out by Professor Hywel Thomas, with a team of researchers from the University of Birmingham’s Centre for Research in Medical and Dental and Education (CRMDE), and the University of Warwick Medical School.

The study is based on data from trainees, trainers and deanery leads gained through interviews, focus groups, case studies, a national survey, and analysis of an ePortfolio database of 11,812 trainees maintained by the RCGP.

The report concludes that the new GP training curriculum introduced in 2007 has been successfully received and that its components - the written curriculum, the ePortfolio and new assessment system for MRCGP - have had a significant impact on the learning experience of trainees.

Findings over the three years of the study demonstrate that both trainers and trainees developed greater confidence and competence using three components of the curriculum, and there was growing recognition and realisation of its future potential in assessment and CPD, particularly in relation to appraisal and revalidation.

It was viewed as a useful bridge between the hospital based and general practice components of training, ensuring the former has a stronger general practice focus.

The report says the curriculum provides clear aims and objectives that ensure broader coverage and relevant learning throughout training, allowing weaknesses to be identified and empowering trainees as self directed learners. It points out that the new curriculum has increased the workload of the trainer, but that new trainers generally welcome the structure it provides.

While the new training curriculum prepares trainees well for clinical practice, the study reports that it does not prepare them fully for independent practice and recommends that the period of general practice training be extended to allow greater consolidation of learning and address gaps in learning practice, and recommends that the period of general practice training be extended to allow greater consolidation of learning and address gaps in learning.

Training for future GPs would ideally provide the skills required for running a business, clinical governance, academic and research skills, as well as providing the necessary experience of continuity of care and, crucially, dealing with uncertainty. English deaneries also need to consider how training can prepare future GPs for their proposed role in the commissioning of services, but this might be achievable only if the overall period of general practice training is extended, says the report.

The study also recommends further work to enhance the reliability of the Workplace Based Assessment component of the curriculum, and for greater consistency in the quality of hospital posts undertaken during general practice training. It highlights instances of user criticisms of the trainee ePortfolio and recommends developments to make it easier to navigate. The College is already addressing both the technical and navigational issues in response to user feedback. The RCGP is also working with the other Medical Royal Colleges to address the shared issue of variation in assessment performance by particular demographic groups.

Dr Bill Reith, Chair of the RCGP Postgraduate Training Board, said: "The GP training curriculum and new arrangements for MRCGP are transforming our whole approach to the training of GPs. The curriculum is an ongoing developmental process which will be constantly adapted to reflect the changing nature of general practice.

“We commissioned this study as a 'stock take' and the research team have produced an excellent piece of work that acknowledges how far we have come, along with sensible recommendations for further development, many of which we have already put in place or are working towards.

"What we did not anticipate was that the findings would make such a compelling case for enhanced GP training which the College has been calling for for some time.

“We are extremely grateful to Professor Hywel Thomas and his team, particularly Dr Julie Bedward, Dr Ian Davison and Dr Sarah Burke, and to Professor Neil Johnson of Warwick Medical School for providing such comprehensive feedback.

“We will continue to build on the work we have started so that we are raising standards ever higher and ensuring that future generations of GPs have the confidence as well as competence to meet the needs of patients in the increasingly complex world of general practice."

Professor Hywel Thomas who led the research adds: “We were delighted to be able to undertake this independent three-year long assessment of GP Training for the Royal College. Our evaluation demonstrated both the overall strength of the new training curriculum as well as identifying some areas of weakness.

The curriculum provides clear aims and objectives that help trainees develop the skills they need to work in General Practice and provides a framework for the trainers who support them. However, while the new curriculum prepares trainees well for clinical practice, it does not fully prepare them for independent practice which includes developing the skills required for running a business, clinical governance, academic and research skills and, crucially, dealing with uncertainty.

With GPs likely to take a leading role in commissioning NHS services in the future these skills will become more important not less. One solution could be to extend the period of training to help embed and consolidate these skills”.